This story is part of our yearlong series “In Pursuit of Health,” covering medical news and research happening across the university.

“The computer therapy gave me confidence to try new things, and I was able to text my granddaughter back when she sent me a text message!” reported one 84-year-old patient.

Technology is everywhere. You see the ubiquitous smartphone or tablet in the hands of the five-year-old in his car seat, the 15-year-old texting friends and the 35-year-old keeping up with the office while vacationing.

Now School of Social Work professor Namkee Choi is using technology in an innovative way for older generations: bringing psychotherapy to aging adults’ homes through Skype.

Choi’s research has shown that medically ill, homebound older adults are more vulnerable to depression than their more active peers. Isolation and multiple stressors, Choi explains, can contribute to the problem.

“When I say isolation, I mean they are isolated from meaningful social engagement or social activities, even if there are a lot of people coming to their house, such as home health care workers, other service providers or informal caregivers,” Choi says. “Older adults depend on other people for so many things, but it can be very stressful to have all these helpers in your home all the time.”

Studies indicate that depressed older adults who take multiple medications for their conditions prefer talk therapy to antidepressant medications. Even so, there is a stigma and discomfort attached to seeking psychotherapy.

Choi experienced that firsthand as a Meals on Wheels volunteer, delivering meals and buying groceries for homebound seniors.

“One of my first grocery-shopping clients in Austin, an 86-year old woman, kept telling me, ‘I am so depressed.’ But she was reluctant to go to any clinic-based therapy because she didn’t want to be seen doing so. In any case, she could not drive and could not afford other transportation, so she really had no way of getting to a therapy session,” Choi says.

That volunteering experience prompted the idea for the Skype study, which focused on depressed, low-income homebound older adults.

Participants, who ranged in age from 50 to 80, were loaned laptop computers with Skype video call installed and prepaid USB 3G wireless cards. They were also provided with a headset for privacy.

Choi’s study, funded by a $680,000 grant from the National Institute of Mental Health, used a method called Problem-Solving Therapy (PST) and compared the Skype videoconference sessions (tele-health PST) to in-person PST and telephone support calls.

PST stems from the theory that people with deficits in problem-solving skills become vulnerable to depression because they may not cope well under high levels of stress.

The program was referred to as “wellness at home” to help seniors move past their sense of stigma related to mental illness. Choi also reassured prospective participants, telling them, “Name one person that you know who didn’t have any depression in life. This is part of life in this earth so you don’t have anything to be ashamed about.”

But there was another hurdle: The seniors were reluctant to use technology.

“Most of the people told me they hoped they got the in-person PST,” Choi says.

Over the course of 36 weeks, participants were evaluated for items such as acceptability of the treatment, likeability of the procedures used and negative aspects, such as any side effects or discomfort with the type of treatment.

Results showed a significant reduction in depression symptoms. And surprisingly, Choi saw higher evaluation scores from the tele-PST group than the in-person PST group.

“About 90 percent of them said that it was a life-changing experience for them,” Choi says. “Some people cried as they talked about how much they’ve changed and how PST helped them get out of depression.”

Choi says they appreciated the privacy of tele-PST, along with the convenience. “They said, ‘Oh I don’t feel guilty about not cleaning my house. I can do it in my pajamas and I can still see the therapist as if she’s sitting right next to me.’”

The biggest bonus of tele-PST was the technology itself, or what Choi calls the “cool” factor. Study participants said they loved using the computer and the videoconferencing system.

“The computer therapy gave me confidence to try new things, and I was able to text my granddaughter back when she sent me a text message!” reported one 84-year-old participant. “I feel empowered by the therapy.”

Choi’s study also received funding from the St. David’s Foundation and the Roy F. and Joann Cole Mitte Foundation. A longer version of this story originally appeared in the School of Social Work’s magazine, The Utopian.

Image credit: iStockphoto

]]>http://www.utexas.edu/know/2013/11/04/video-chat-depression-therapy/feed/0The power of the Internet over depressionhttp://www.utexas.edu/know/2012/02/06/homebound_adults_depression/
http://www.utexas.edu/know/2012/02/06/homebound_adults_depression/#commentsTue, 07 Feb 2012 01:02:00 +0000University Communicationshttp://www.utexas.edu/know/?p=23624Namkee Choi noticed a recurring problem while working as a Meals on Wheels volunteer in three states over 15 years.

Namkee Choi, professor in the School of Social Work at The University of Texas at Austin, is using technology in an innovative way to curb depression among homebound adults. Photo: Marsha Miller

A number of the older adults to whom she delivered meals suffered from depression and were unable to get help for their illness. They couldn’t afford treatment or didn’t have transportation to get to a clinic regularly.

Her idea: Use the Internet to connect homebound clients and psychotherapists.

Nationally, depression affects more than 6.5 million of the 35 million people aged 65 years or older, according to the National Alliance on Mental Illness. Rates are higher among those who are homebound or ill.

Those affected desperately want treatment, Choi said.

“When you are in that situation — a terrible, terrible depressed mood — you want help. You really look for help,” she said. “They are very honest in admitting their depression.

“When they’re depressed, they don’t have energy,” Choi said. “Their house is cluttered, and they can’t take care of their business (paying bills and the like).” Other problems clients reported included physical limitations, other mental health problems, family conflict and social isolation.

Choi, whose research has focused on aging issues, won a $450,000 grant from the National Institutes of Health and received supplemental grants from the Roy F. and Joann Cole Mitte Foundation and the St. David’s Foundation, both based in Austin, and set up a pilot study to test her idea.

Choi worked with Meals on Wheels and More in Austin to recruit participants for the study. Choi has been a Meals on Wheels and More volunteer and is currently an advisory board member.

During periodic in-home visits and assessments with Meals on Wheels and More clients, case managers identified prospective participants by administering a widely used depression screening scale, said Linda Perez, the agency’s assistant vice president of client services.

For clients whose score indicated at least a moderate level of depression, the case managers provided a description of Choi’s project and asked them if they would be willing to participate. Those who consented were put in touch with Choi.

In the pilot study that began in late 2009, Choi has provided Dell laptop computers to 54 homebound older adults. The computers were loaded with Skype, a free videoconferencing program, and equipped with a cellular network card to provide an Internet connection.

Mary Lynn Marinucci and Leslie Sirrianni, who graduated from the School of Social Work with master’s degrees, provided the clients with an evidence-based, short-term and structured therapy called Problem Solving Treatment (PST).

PST has been found effective in dealing with depression for all age groups. The therapy was provided in six weekly sessions followed by six monthly telephone booster sessions.

A few minutes before a Skype therapy session, the social worker gave the client a reminder call. All the client had to do was press the computer’s “on” button to bring up Skype.

— From Further Findings, a blog about University of Texas at Austin research that goes beyond the results.

Then for the next hour the client and the therapist engaged in a tele-PST session.

In the project, another group of 43 homebound older adults received one-on-one, in-person PST from the same social workers-therapists in their homes. A third group of 34 homebound older adults received six weekly telephone support calls from two social workers who were not trained in PST. The in-person PST group and telephone support group served as controls to the tele-PST group.

Following six weeks of PST or telephone support, follow-up interviews were done with each participant at two, 12 and 24 weeks.

The depression outcomes for the tele-PST group and the in-person PST group were not significantly different from each other, but the participants in both groups scored significantly lower on depressive symptoms than those who received telephone support calls, Choi said.

The sample size for the study was not big enough to draw definitive conclusions, Choi said, “but we really can see tele-PST’s potential as an effective depression treatment approach among depressed homebound older adults.”

Choi also said that the participants accepted the technology. Some were enthusiastic about it. Even technical glitches didn’t seem to bother them, Choi said. When a computer screen would freeze or a connection would drop during tele-PST sessions, the clients took it in stride. However, some participants were annoyed when an advertisement popped up on the screen.

Perez said Meals on Wheels and More clients who participated in the therapy love it. “They really see improvement, and we see it really has helped them.”

She said some clients have been able to discontinue Meals on Wheels and More services after the therapy.

“That’s a good thing,” Perez said. “They were receiving meals because they were unable to prepare their own meals and get out and do things for themselves due to depression and/or disability.”

After the therapy, she said, some of the clients went out to senior centers and other places they had shied away from.

Perez said that Meals on Wheels and More staffers were surprised that the clients responded so well to using technology.

“Let’s say they didn’t have a good day and they just didn’t want to have somebody come into their home because they didn’t get to clean up,” she said. “This is a way to still be able to work through their issues because they’re able to engage in a therapy session via videoconferencing.”

Choi is pursuing a bigger test of the concept with a research project that would run in Austin and New York City. She is applying for a grant from the National Institutes of Health.

Choi continues to investigate technology for the project. Game devices, iPads and other tablets, and smartphones could be used. Devices that connect to a television would provide a bigger image.

Who knows? When it comes to treating depression, Choi might have an app for that.